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iSpine Discuss More Annualr Tear info.. in the Main forums forums; I have a few questions, so please chime in if you feel you can help. Does anyone one no anybody ...

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Old 04-14-2011, 09:51 PM
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Default More Annualr Tear info..

I have a few questions, so please chime in if you feel you can help.

Does anyone one no anybody who has healed an annular Tear?

Haven't all herniation's at one time begun as an Annular tear and if so once they become herniation's there are more surgical options?

From reading "Medical WEB sites" all Dr.s are quoted as saying that the only success with Tears is a Fusion or ADR. This assumes the Disk has lost considerable height. Outcomes with a disk with good height are not as positive. (Any thoughts).

What surgical procedures are available for Central Tears or Central Herniation's?

Are tears that radiate more to the leg and less at the back a clue for anything?

Thanks in advance and I hope Mark will chime in.
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Old 04-15-2011, 06:53 AM
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Does anyone one no anybody who has healed an annular Tear?

>> Yes. Read AnnC story on GPN webpage. SED failed at L4-5, but was completely successful at L5-S1. Disc held full pressure with no pain.

Haven't all herniation's at one time begun as an Annular tear and if so once they become herniation's there are more surgical options?

>> As the disc breaks down the annulus becomes compromised. It bulges and ultimately tears. I don't understand the rest of this question.

From reading "Medical WEB sites" all Dr.s are quoted as saying that the only success with Tears is a Fusion or ADR. This assumes the Disk has lost considerable height. Outcomes with a disk with good height are not as positive. (Any thoughts).

>> I would think that better height would mean better success.... it would just be a less severely degenerated place to start from... a less severe problem. The better off you are before your surgery, the more likely success is. I would think that a better situation would be a better candidate for SED or other MISS options. I don't know a surgeon who would recommend fusion or ADR in a disc that is a good candiate for a simple discectomy.

What surgical procedures are available for Central Tears or Central Herniation's?

>> The more centrally located, the tougher it is to consider MISS. My wife's herniation was so severe and very centrally located that even the top MISS surgeons in the US would not have done her discectomy endoscopically. Tom Hoogland did and excellent job with an endo discectomy that was very successful. (Unfortunatly, she was not lucky enough and reherniated in 3 months.)

Are tears that radiate more to the leg and less at the back a clue for anything?

>> Better candidate for discectomy. They are good at leg pain but not for discogenic LBP. (Except SED or other thermal annuloplasty procedures.)

Thanks in advance and I hope Mark will chime in.

>> Your welcome!!! Chiming done!
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Old 04-15-2011, 02:16 PM
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Mark, thank you for your responses.

One example is Spine-Health.com you will find information about treatment options for Annular Tears as well as an interview by a Dr. Peter Ullrich. He states the options for a tear are Fusion and ADR. He also states that there is less success with a patient that has good disc height and a tear. So not sure what most of that means, so do you "believe what the DR. says?".

You mention Ann C.'s story as success. I was wondering if there was anyone out there that had a tear heal without surgery?

As for my situation I have primary sciatica. MRI shows a Hiz sign with no neural compression. So I'm dealing with Chemical Radiculopathy. So would a discectomy still be helpful? It's pretty strange that my tear is central to the right, but my symptoms are primarily on the left.

Thanks for any input.
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Old 04-15-2011, 06:23 PM
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Default annular tear

I've had one at L3 for a long long time. It's been non cordant for pain on 2 discograms. If it's gotten worse it's not been symptomatic or if it's been symptomatic it's not been something that I've really noticed. L5S1 had discectomy years ago and rebulged and finally autofused. Big change in pain levels/flare ups since then. L4 discectomy and rebulged. Still have some probs from this one.
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Old 04-15-2011, 07:57 PM
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I had a Grade 5 Annular Tear March 2010 at L5/S1. At March 2011 it was a 8mm Disc Extrusion.

Still have good disc height.

Have had LBP since late 2008.
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2011 ?
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Old 04-15-2011, 08:29 PM
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Maria, Your pain at L5/S1 is worse or better since autofuse? When it "rebulged" did your symptoms worsen and then settle down? Do you think your pain / flare ups is coming from L4?

Longroad, are you going to go down the "surgical road" or wait it out?

My sciatica is bothersome and prevents me from being as active as I like. Sitting is a challenge, but I don't feel my pain level is strong enough to warrant surgery. Not sure what to do or when to do it. But I've learned from my cervical surgery that rushing is not usually a good plan.
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Old 04-15-2011, 09:50 PM
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1)better
2)hard to say because L4 was involved then too and no discogram offered/done back in early '90s to 2001)
3)yes

Used to have pain that was attributed to L3 and it was very different than anything I've had in quite a number of years. It eventually stopped altogether even much before I was getting ESIs done on L4 and L5S1.
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Old 04-16-2011, 11:36 AM
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Quote:
Originally Posted by cp7959 View Post
I have a few questions, so please chime in if you feel you can help.

Does anyone one no anybody who has healed an annular Tear?

Haven't all herniation's at one time begun as an Annular tear and if so once they become herniation's there are more surgical options?

From reading "Medical WEB sites" all Dr.s are quoted as saying that the only success with Tears is a Fusion or ADR. This assumes the Disk has lost considerable height. Outcomes with a disk with good height are not as positive. (Any thoughts).

What surgical procedures are available for Central Tears or Central Herniation's?

Are tears that radiate more to the leg and less at the back a clue for anything?

Thanks in advance and I hope Mark will chime in.
I completely forget to mention that my mom has annular tears at L1-L2 and L4-L5. At booth discs she underwent PLDD as precaution. New MRI does not show further degeneration or herniation. I suppose PLDD has helped.
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Old 04-16-2011, 07:56 PM
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Default annular tears

Docs I have spoken with have told me they do not heal due to the lack of blood supply. I finally had surgery as I had a chemically sensitive disc about 1 1/4 years ago. Although I have had two rough periods, In general I am glad I did the surgery. From what I understood the entire disc really needs to come out either through ADR or fusion depending on other factors.

My nerve pain is gone from the chemically sensitive disc. I've had many good months. In an article I found by a doctor who is very familiar with chemically sensitive discs he says that people who have surgery with this do better after surgery. That is what helped me make my decision. He's a very good doctor who did my discogram. I can look up the article if you wish.
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Old 04-16-2011, 09:40 PM
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DR thanks for the response. I have read many WEB sites from Dr.'s as well as Chiro's, PT's and potential patients. Everyone has a different view. Even Laser Spine Institutes Marketing machine say's most Tears heal on there own.

I did read many times that Fusion and ADR is the only "fix". However my Surgeon who has done my fusions, ADR removal and ADR says if needed he would only need to remove part of the disc. Mark's view is a disectomy could be a solution as well.

So many mixed messages.My feeling is only time will tell for each individual case.

You have a (2) level lumbar fusion? How is your pain level and range of motion? Was recovery tough? How close to "normal" do you feel?

I really appreciate the feedback. Back / neck problems are terrible.
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